1. Factors influencing health status Chapter 10.

2. Key Knowledge and Key skills  Key Knowledge  The influence on the health status of developing countries compared to Australia of income, gender equality, peace/political stability, education, access to healthcare, global marketing (of alcohol, tobacco and fast/processed foods) and physical environments.  Key Skills:  Compare factors that influence the health status and human development of Australia and developing countries

3. Intro..  Around the world, major differences exist between developed and developing countries in relation to income, gender, education, healthcare, political stability (including peace), global marketing and environments. These differences have a significant impact on the health status of Australians and those people living in developing countries. Inequalities in health status can be measured as a result of these factors.

4. Differences in global health  The differences in health status are the result of a number of factors.  In Australia, many of these are lifestyle factors that can be said to be within an individual’s control, such as diet and exercise.  In developed countries, some of the major influences on health status include smoking, stress and food intake that is high in fat, salt and sugar.  In many developing countries, however, resources that are taken for granted in developed countries, such as a safe water supply, are not readily available or are totally absent. Such factors can be seen to be largely outside an individual’s control and can have serious impact on the health of individuals and entire communities.

5. Differences in global health  In this chapter, we will look at the impact the following can have on the health status of developing countries compared to Australia:  Income,  Gender equality,  Peace/political stability,  Education,  Access to healthcare,  Global marketing (of alcohol, tobacco and fast foods)  Physical environments.

6. The influence of income  Income has a significant impact on health status. This impact can be felt on two levels.  Both the income an individual/family receives for the work they perform and the income of the country itself can have a significant impact on health status.  A country that is experiencing poverty is typically unable to provide such resources such as safe water and sanitation, education, social security and adequate healthcare.  The consequences are low literacy and immunisation rates, high maternal and infant mortality, and high rates of infectious disease,

7. The influence of income  In developing countries many families may be living in poverty.  There is a direct link between a lack of income, poverty and ill health as people who live in poverty have lower levels of nutrition, education and healthcare.  Poverty means that people do not have their needs met in relation to basic human requirements such as food, clean water, healthcare and education, nor do they have the opportunity and choice to improve their living standards.  In Australia there are still many families living in poverty for reasons associated with, for example, low wages or unemployment, disability or being a sole-parent family  One significant difference for people who have a lack of income in developing countries compared to people that have a low income in Australia is that due to the GDP of Australia.  As a result of the higher GDP, the Australian government can provide a wide range of services such as social security (Welfare payments e.g. age pension and youth allowance), healthcare and education to protect the health of Australians.

9. The influence of income on health Influence on health in Australia Influence on health in developing countries Relatively low unemployment rates=more people have access to healthcare, food and shelter which reduces illness and promotes mental health. No social security reduces the income of individuals and families, which contributes to poverty. Higher GDP increases the money available to spend on healthcare (Medicare) and education. Poverty leads to lower literacy rates, which contribute to poverty – people are less likely to be able to break the poverty cycle. A higher GDP also means more money is available for social security to support individuals with lower incomes increasing their access to healthy foods and healthcare to promote their health. Low-income countries are associated with reduced access to safe water and sanitation, education, healthcare and social security. As a result they have low immunisation and literacy rates, and high infant and maternal mortality rates. Low GDP means less money is spent by governments on health and education.

10. The influence of gender equality  In Australia, females experience most of the same opportunities as males. The laws protect the rights of both males and females and both sexes are provided with equal opportunities in relation to education, work and leisure.  This is not the case in all countries. The status and treatment of women in many developing countries lags behind that of men in almost all areas, including access to education, income, employment and legal rights.  This means women are often denied access to resources that will keep their families and themselves healthy.  http://www.youtube.com/watch?v=KxECHRlrHu8 http://www.youtube.com/watch?v=KxECHRlrHu8

11. The influence of gender in developing countries  Life starts unequally for females in many parts of the world, and stays that way.  The birth of a boy is celebrated with joy in many developing countries, while the birth of a girl is considered to be a disappointment, which may lead to feelings of guilt in the mother.  Women and children are always helping the family to survive. Among their many tasks is the responsibility for collecting water for drinking, cooking and washing. Often the nearest source of water is a long way from home, which makes the transportation (on foot) an exhausting and time-consuming task.  Domestic duties leave little or no time for children, especially girls, to attend school. Girls are often earning a living by the age of 10, and expected to work as many as 12–16 hours a day, which can lead to all kinds of health problems, including chronic exhaustion.

12. Gender and labour roles.

13. The influence of gender in developing countries  Women also tend to marry young and give birth to many children.  Reasons for these large families may include:  Cultural barriers to family planning  The fact that a large proportion of children die under the age of five  Children being viewed as a form of social security for parents in old age  more children = more people to work for the family to provide food-a sad reality.  Many women in developing countries also face a lifetime of violence and exploitation.  According to UNICEF, a study of rural villages in India found that 16% of all deaths among pregnant women were due to partner violence.

14. Gender inequality As can be seen in the table, many developing countries such as Afghanistan an Zambia have a high GII, while Australia, which is ranked 18th in the world, has a much lower GII of.136. The Gender Inequality Index (GII) is used by the United Nations as part of the HD Index to measure gender inequality

15. Gender inequality.  Girls in developing countries face many barriers to health and development, and they are often denied the opportunity of an education and to experience childhood.  Two serious issues for girls in developing countries include  Exploitation  Being forced into adult roles such as;  Marriage and motherhood, while they are still children.  Child labour

16. Gender inequality-Adult roles  Many children in developing countries are asked to grow up very quickly when compared to their counterparts in developed countries.  Female children, in particular, are expected to fulfil adult tasks as a normal part of their everyday lives. These tasks include helping to care for their siblings or taking responsibility for earning part of the family’s income.  Some adult roles that children in developing countries assume can actually pose a significant risk to their health, wellbeing and development.  These include:  marriage,  childbirth and  dangerous labour.

17. Gender inequality-Marriage  Many girls in developing countries under the age of 18 are married and forced to assume the adult role expected of a wife: sex, motherhood and household duties.  Why do you think force marriages, in particular before the age of 18, can be detrimental to a girls life??  Forced marriage, particularly before the age of 18, can put an end to educational opportunities and also trap women who have few rights into a life of domestic and sexual compliance.  Early marriage can also have a significant impact on a girl’s physical health and development due to pregnancy and childbirth.  Both pregnancy and childbirth carry an increased risk of infant mortality and may cause devastating physical damage on a young girl’s body which is not yet developed enough to carry and deliver babies safely to term.  Girls who give birth under 15 years of age are five times more likely to die in childbirth than women in their 20s,

18.  Case study/article on young girls being forced to marry and have children in developing countries??

19. Percentage of women 20-24 years old in the developing world who were first married before ages 15 and 18 by region

20. Forced marriage and child birth.  http://www.youtube.com/watch?v=pJr3ZSPIkbU http://www.youtube.com/watch?v=pJr3ZSPIkbU

21. Activity  Activity 10.1 (pg 336)

22. Gender inequality-Child labour  Many girls aged 5–17 years in developing countries are involved in child labour.  Working in dangerous conditions is a common situation for many of these children.  This can result in injury, disability or death.  Being forced into paid work from a young age also denies many girls an education and the opportunity to have a childhood, both of which will impact on their health and development at various stages throughout their lives.

23. Gender inequality-Exploitation  The trafficking of children is a serious concern in some developing countries. Some children are forcibly abducted, others are tricked and some allow themselves to be trafficked in order to make money.  Many of these children are forced into sex work, hazardous labour or domestic service.  Girls are at much greater risk than boys.  Being removed from their family and community means these children are isolated and very vulnerable (often they are taken to a place where they are unable to speak the language).  Exploited children are often malnourished, suffer physical abuse and punishment, are at extreme risk of sexual abuse (even if not being trafficked as sex workers), may be forced into hazardous physical labour and, as a result, their health and development will be seriously compromised.

24. Gender inequality-Exploitation  http://www.youtube.com/watch?v=pS0deWfaheo http://www.youtube.com/watch?v=pS0deWfaheo

25. The influence of gender equality on health Influence on health in Australia Influence on health in developing countries In Australia, boys and girls usually have equal access to education and other resources such as healthcare. Due to poverty, many girls in developing countries are forced into marriage at a very young age = increased rate of infant and maternal mortality in developing countries. There may on occasion be differences in the way boy and girls are treated and the roles they fulfil within the home but these differences are unlikely to result in differences to health. Due to a combined risk of poverty and conflict, girls may be at risk of being trafficked, forced into prostitution or child labour, leading to under-nutrition, abuse and violence. As a result, our teenage pregnancy rate is much lower in Australia, compared to developing countries. This leads to lower maternal and infant mortality rates Differences in culture mean females are generally less educated than males. In Australia, the ratio of boys and girls attending primary and secondary school is similar, reducing the inequalities between the genders

26. The influence of education  Nearly a quarter of the world’s population is illiterate and nearly two- thirds of this number is made up of females.  Not being able to read or write can lead to a reduction in health status, especially among women.  In Australia almost all children (both boys and girls) attend primary and secondary school, which is compulsory until the age of 15 or 16, depending on the state or territory. As a result, the literacy rate in Australia is also higher.  Education is a key factor in the fight against  poverty. Children who attend school will have  more employment options as adults and usually  experience better health.

27. The influence of education on health Influence on health in Australia Influence on health in developing countries Higher percentage of GDP being spent on education compared to many developing countries increases access to education. Lower percentage of GDP being spent on education in many developing countries reduces access to education. Increased access to education contributes to higher literacy rates. Poverty also contributes to reduced access, especially for girls, who are sent to work at a young age. Literacy increases choices in relation to employment, which can improve health status Poor access to education contributes to low literacy rates and illiteracy reduces choices and reduces the possibility of people being able to break the poverty cycle. Lack of education contributes to the inequality between males and females.

28. The influence of access to healthcare  The issue of healthcare in many developing countries is as much about the availability of services as it is about funding.  Developing countries have far fewer doctors per capita in comparison with developed countries.  Australians are fortunate to have a government funded health care system in the form of Medicare. In the poorest countries there is no such healthcare system.  Access to healthcare includes both immunisations and maternal HC.  Access to primary healthcare is vital to improve health in developing countries.  Primary healthcare (PHC)- Is defined as essential healthcare. PHC has been seen as one of the keys to reducing health inequalities  Read pg 343-345 on PHC

29. The influence of access to healthcare  The governments of many developing countries do not allocate as much of their budget to healthcare as they do on other areas such as education and defence.

30. Access to healthcare-Immunisations  Millions of children in developing countries die each year from diseases – among them measles, whooping cough, tetanus, polio, tuberculosis and diphtheria – that can easily be prevented with immunisation  Over the past 30 years, global coverage of immunisation has increased from 10% to 70–90% and has saved millions of lives  In many developing countries, immunisation is funded and conducted by aid agencies. A lack of access to healthcare services may be one barrier to children in developing countries being immunised. Routine immunisations are also carried out in developed countries such as Australia.

31. Immunisations  DPT A series of 3 vaccinations to prevent diphtheria, pertussis and tetanus.

32. Maternal and child health  Significant inequalities exist between Australia and many developing countries in relation to maternal and child health.  In developing countries, many women are still not receiving the amount of care they need during pregnancy and labour.

33. Influence of access to HC on health Influence on health in Australia Influence on health in developing countries Due to a well-established govn’t-funded healthcare system in Australia, most Australian have access to a high standard of healthcare for little or no cost. Fewer doctors per capita and a lack of govn’t funding for resources in developing countries contributes to poor access to healthcare and therefore poor health. This leads to a low number of deaths from communicable diseases and longer life expectancy. As in developed countries, it is those in rural areas who have less access to medical services, increasing the risk of illness for these people. In Australia, most women also receive antenatal care and deliver their babies in hospitals, which reduces the infant and maternal mortality rate. A lack of access to healthcare countries contributes to lower immunisation coverage and high rates of communicable diseases. Access to free immunisation and financial incentives in Australia have increased immunisation rates Poor access to trained birth attendants, pre- and postnatal care and infant growth monitoring in developing countries contributes to under-five, infant and maternal mortality.

34. The influence of peace and political stability  Political stability- is another factor that can contribute to differences in health between Australia and some developing countries.  A stable government is an important tool in the promotion of development. Effective governments develop laws, maintain order and stability, and provide for the protection and advancement of human rights. They also provide education and health services.  Often political instability results in war or conflict in a nation, which contributes to an increase in poverty and decrease in health status.

35. The influence of peace and political stability  Peace- Peace and political stability are closely related.  Democratic and stable governments promote peace and in times of peace, governments tend to be more stable.  Peace is an important factor that contributes to good health. People that live in countries that experience peace have more freedom, opportunities and choice about their own lives.  The opposite of peace is war or conflict and people who live in countries that are experiencing conflict tend to have less freedom, opportunity and choice and have fewer resources that are needed for health.  Therefore those living in war/conflict experience poorer health due to lower life expectancy and literacy rates etc.

36. Influence of peace and political stability on health Influence on health in Australia Influence on health in developing countries A stable political environment and a democratic government have contributed to a history of peace. Some governments in developing countries are not very stable due to corruption, conflict or a lack of democracy. This means that people have more choices, a larger per cent of GDP is spent on health and education, human rights are respected, and there is less discrimination, less poverty and increased life expectancy. People have fewer rights, less access to healthcare and education due to money being spent on the military, discrimination based on gender or religion and reduced life expectancy. Times of peace also contribute to less violence, injury and premature death.

37. The influence of global marketing (alcohol, tobacco and fast food)  ‘Global marketing’, refers to the advertising and selling of goods and services all across the world.  In recent years global marketing has become an issue.  This is due primarily to the rapid advancements in technology, communications, science, transport and industry.  Global marketing has both advantages and disadvantages:  In relation to developing countries specifically, some would argue that global marketing is a positive tool that can be used to aid in the reduction of poverty if a number of key issues are addressed.  On the other hand, global marketing can contribute to ongoing poverty and disparities in wealth between developed and developing nations.

38. The influence of global marketing (alcohol, tobacco and fast food)  In today’s society, global marketing is seeing the following products marketed in developing countries:  Tobacco  Fast food  Alcohol  Developing countries are soft targets and easy markets.  Campaigns to warn about the dangers of tobacco, alcohol and processed foods are rare, unlike in developing countries.  As a result, individuals in these countries are unaware of the risks associated with tobacco, fast food and alcohol.

39. The influence of global marketing (alcohol, tobacco and fast food)  How can global marketing and the marketing of, in particular, tobacco, fast food and alcohol effect the health status of developing countries?  Global marketing of tobacco, alcohol and fast food is contributing to the double burden of disease where individuals face the threat from communicable diseases such as HIV/AIDS and malaria but now also a wide range of non-communicable diseases including cardiovascular disease, obesity, type 2 diabetes and cancer.

40. Global marketing-Fast food  Global marketing has resulted in a greater variety of foods in developing countries, foods which were non existent up until a few years ago and are now contributing to the changes we are seeing in the health of developing countries in particular.  In many developing countries, the consumption of unhealthy fast food is reaching, and in some cases exceeding, the level witnessed in high- income countries.  As a result, there are now a number of developing countries where under- nutrition and obesity are both significant health concerns.  In developing countries in particular, these fast foods are generally low in cost and easily available.

41. Global marketing-Alcohol  Increased availability and changes in trade arrangements and marketing by multinationals have also lead to an increase in alcohol use in some developing countries.  Alcohol misuse can contribute to cancer, cardiovascular disease, cirrhosis of the liver, mental illness, injuries, traffic accidents and premature death.  Those in developing countries are particularly vulnerable to the various social consequences of alcohol such as poverty, under-nutrition and violence.  http://www.youtube.com/watch?v=VJuxvA_NVCU http://www.youtube.com/watch?v=VJuxvA_NVCU

42. Global marketing-Tobacco  The past 20 years have seen a dramatic increase in the number of people in developing countries who have taken up smoking. Tobacco is now one of the fastest-growing causes of deaths from lifestyle-related, non- communicable disease.  Each year, about 6 million people die throughout the world from tobacco smoking or being exposed to tobacco, with many of these deaths occurring in developing countries.  Tobacco companies have moved their target away from high-income countries to more vulnerable developing countries. WHY??  Many developed countries, including Australia and the USA, have enforced laws and legislations including the banning of tobacco advertising and warnings.  In developing countries the marketing of tobacco by multinational companies to a vulnerable population continues unchecked.  http://www.youtube.com/watch?v=BJ40hgRb2b4 http://www.youtube.com/watch?v=BJ40hgRb2b4

43. Influence of global marketing on health Influence on health in Australia Influence on health in developing countries The smoking rate in Australia has been declining over the past 20 years due to the work of the Govn’t in addressing the issue. Increased use of tobacco and alcohol in developing countries has increased the number of deaths due to tobacco in developing countries. There are also efforts in Australia to address poor eating behaviours and reduce obesity rates. It is also contributing to under-nutrition when families purchase tobacco or alcohol instead of food. Global anti-tobacco marketing has been effective in Australia and many developed countries have shared their experiences in addressing smoking rates. Increased consumption of processed foods is contributing to the double burden of disease as those in developing countries are now at risk of under-nutrition and obesity. Chronic NCD’s are still an issue, but due to a well-established HCS Australians are better able to manage them. The HC system is not established and people are not having these conditions managed in the early stages, increasing the mortality rate.

44. The influence of physical environments  Environments refer to an individual’s surroundings and examples may include physical, social, economic and political environments within the area that they live.  There are many issues relating to the environment that impact on health. These include:  Climate change  Food security  Access to water and sanitation.  Shelter and housing

45. The influence of physical environments-Climate change  Climate change is a result of global warming and is a rising concern in today’s society.  The effects of climate change include the expansion of deserts through poor rainfall, rising sea levels, increase in flooding and a change in weather patterns such as those causing cyclones  It’s the poorest nations that will be hit hardest by these natural disasters.  Given that these poor nations don’t have the resources to cope with such disasters there is an increased level of health risks, in particular the increased spread of diseases such as malaria.

46. The influence of physical environments-Water  Having access to clean, safe drinking water is something that people in developed countries have long taken for granted  Having enough water is one concern, but having access to water that is safe is another concern for those in developing countries.  There are over 1 billion people living in developing countries who lack the assurance that the water they drink is free from contamination.  Unsafe drinking water can result in the spread of illness such diarrhoea, cholera, malaria and hookworm.  WHO has estimated that 80% of all sickness and disease in the world is attributable to inadequate water or sanitation

47. The influence of physical environments-Water  Not having access to a safe water supply does more than spread disease. As a consequence of drought, rural communities often lack sufficient water to grow food or to keep their cattle alive. Without this essential resource, farms can wither; for people already struggling to survive, life becomes even harder. Why might water sources such as the one illustrated here pose a threat to health?

48. The influence of physical environments-Provision of food  The term food security refers to all people having access to an adequate, safe and nutritious food supply at all times  People in developed countries, such as Australia, have a plentiful and varied supply of food, while there are many countries in the world where food is scarce.  In developed countries, the abundance of food sees people suffering from health conditions and diseases associated with excessive consumption of foods rich in fats, salt and sugars.  In developing countries, on the other hand, a lack of food also leads to a variety of health issues associated with hunger and under-nutrition. There are many people, especially in rural areas, who are hungry and suffer from the effect of under-nutrition, while there are others in urban areas who are suffering the same ‘lifestyle’ diseases caused by an increase in the availability of processed food-due to Globilisation!

49. The influence of physical environments-Shelter and housing  Most Australians live in homes that have access to safe water and sanitation as well as electricity and gas to provide cooling and heating and to run appliances for cooking.  In many of the least developed countries in the world, many families do not have access to the most basic forms of shelter to provide protection from the elements and, as discussed earlier, many do not have access to safe water and sanitation.

50. The impact of physical environments on health Influence on health in Australia Influence on health in developing countries In Australia, food security is not a significant issue for most people. In theory, the country produces more than enough fresh and healthy food for the population. Food security is largely influenced by climate, and expanding deserts and rising temperatures mean that many developing countries will experience further reductions in the growth of crops and therefore their food supply. This increases the risk of under-nutrition. The climate can still have a devastating impact on crops and health as was seen in the Victorian bushfires or the Queensland floods. Changes in weather patterns may also increase the risk of floods, cyclones and other disasters that will reduce food supply, increase under nutrition and increase the spread of disease. In Australia, people have access to a clean and safe water supply and adequate sanitation facilities. This has a huge impact on reducing the rate of communicable diseases Reduced access to clean water and sanitation facilities increases the spread of disease, which causes dehydration and under-nutrition. This increases the infant and U5 mortality rate. Access to adequate clean water is vital for health. It is needed to grow crops and for drinking.

51. Global Health  Complete Activity 10.5 pg 366  (A summary of the factors contributing to the difference in global health)

53.  http://healthandhumandevelopmentcsc.weebly.com/the- influence-of-income-gender-equality-peace-education- access-to-healthcare-political-stability.html http://healthandhumandevelopmentcsc.weebly.com/the- influence-of-income-gender-equality-peace-education- access-to-healthcare-political-stability.html  A walk to beautiful-Big picture of global health